The role of dentistry in head and neck radiation therapy

In the adult patient, oral complications of cancer radiotherapy stem from the deleterious effects of radiation on salivary glands, oral mucosa, mandibular musculature and alveolar bone. Clinical consequences of such treatment include xerostomia, rampant dental decay, mucositis, taste loss, osteoradionecrosis, infection, trismus, and nutritional stomatitis. These alterations to the normal state occur both during and after completion of head and neck radiation. Fig. 1 outlines the time frame involved in the development of each particular problem. In the past 20 years, many changes have occurred in the management of patients receiving radiation therapy. The traditional regimen of dental care in these patients was one of extracting all teeth encompassed by the radiation field. However, 15 years ago, this concept was questioned due to the incidence of post radiation caries (PRC) outside the zone of irradiation. The purpose of this paper is to review the major consequences of radiation treatment to the head and neck as well as outline the role of the dentist in the management of these patients.